4. Use silent marketing in your practice.
I hate being a salesman, but I am very good at it. Like you, I do not appreciate people being in my face about things they think I need. I focus much of my practice on evaluating and adjusting the feet. Few patients have been exposed to any of this and many of them have no clue as to why this could be important.
So I use displays, brochures, posters, product samples, and my office staff’s knowledge to give subliminal cues to prompt people to ask questions. Often, patients play with my shoe and orthotic displays while they wait for me to take them back to the treatment room.
This will work well for those of you who work with a lot of nutritional supplements, exercise and rehabilitation, and other things. Let silent marketing sell for you. Education usually equals acceptance.
5. Stay up to date on technology and tell everyone about it.
Patients notice if you keep current with the times. When you look at new technology, don’t just dismiss it without thinking it through using your heart and your business sense. Many available technologies can do amazing things for our patients. If you can help your patients, stay current with new technology, and have it be financially advantageous for your chiropractic business, then why not? “Oh, I just don’t want to spend the money.” I get it because I’ve been there.
However, when you look at technologies like the 3-D foot scanners, lasers, vibration plate therapy, fancy chiropractic tables, or whatever item you are thinking about bringing into your practice, use your head and don’t let fear be the reason you decline. Talk to your CPA or financial adviser for guidance. If you can get a write-off or depreciate the equipment while you offer a new service to your patients, then everyone wins.
If your patients do not know all the conditions or problems you can help people with in your office, it’s not their fault—it’s yours! Patient education happens gradually, but hopefully it advances each time you encounter your patients. I know you probably have read these types of articles already, but I hope you gleaned something new from my five tips. You’ll know that you are doing a good job with patient education when referrals start to flow into the practice. It’s especially nice to receive referrals for cases not typically considered classic chiropractic.
Dr. Kevin Wong is an expert on foot analysis, walking and standing postures and orthotics. Teaching patients and chiropractors is a passion for him, and he travels the country speaking about spinal and extremity adjusting. Dr. Wong practices full-time in Orinda, California. Contact Dr. Wong at 925-254-4040 or [email protected].
What to do now:
- Learn how to perform a proper consultation that creates value for your patient.
- Learn how to communicate the value of what the patient will receive under care.
- Learn how to convert the patient to a cash-paying patient once the minimal insurance runs out.
- Make sure that your procedures will be able to handle an influx of new patients.
- Make sure that your staff is amply trained to handle the extra flow.
- Make sure your organizational skills will afford you the ability to manage more patients.
- Create meaningful follow-up campaigns for those patients that choose to leave care after their insurance runs out.
Scenario #2: Everything that occurs in the first scenario, but in 2015, insurance companies wake up and realize that all of their newly insured clients have “flooded” the system. Insurance companies are forced to raise premiums 300% (yes, 300%). Co-pays rise to a normal rate of $85 per visit (they are close to that now in the Carolinas) and normal deductibles rise to $1,500 (many plans are $1,000 now). When patients are forced to pay $85 per visit and have a $1,000–$1,500 deductible, essentially a cash practice is created.
What to do now:
- Build up cash reserves that equal one year of business and personal expenses. Do this by starting small. Just put away $2 per day every day.
- Learn all of the communication skills listed in scenario #1. The only way to thrive is to be able to create tremendous value for your patient in the consultation and every visit there-after.
- You must learn to market strategically, not tactically.
- You must be well organized so you will have time to market, train, and work on your practice.
- You must become business-savvy.
- You will want to develop cash-based services in addition to your insurance-based services.
Being prepared is the key to achieving success during any transition. Since nobody has any certainty about what will happen with the new law, it is incumbent upon practitioners to position themselves in a way that their practices will continue to survive and thrive no matter what happens. Remember, you can do anything that you put your mind to. If you are unable or unsure about what to do, ask a friend, colleague, or hire a professional to help you. Please do not bury your head in the sand by taking no action at all. That is a surefire recipe for disaster.
Dr. Paul S. Inselman, President of Inselmancoaching, is an expert at teaching chiropractors how to build honest, ethical, integrity-based practices based on sound business principles. From 2008-2012 his clients practices grew an average rate of 145% while the general profession was down 28%. His 26 years of clinical experience coupled with 10 years of professional coaching has allowed him to help hundreds of chiropractors throughout the nation. He can be reached at 1-888-201-0567 or to schedule a free no obligation consultation go to https://www.timetrade.com/book/JNW2J . His e-mail is [email protected] .
The unassuming Dr. Morgan, who prefers to be known as just Bill, was gracious enough to accept my request to visit him at the hospital. Keep in mind, I was expecting to see straightforward chiropractic, but what I saw far exceeded my expectations.
The purpose of my story is not to list Dr. Morgan’s (Bill’s) lengthy accolades. His CV is book length and his numerous awards are, if you ask me, “too many to count.” (If interested, visit: http://drmorgan.info/home.) What I want to convey, though, is that I experienced a very friendly, caring, energetic guy who is excited about his work, has an unselfish desire to share, and possesses a terrific command of the subject. Bill told me he is just an average chiropractor, but I beg to differ.
I drove to Walter Reed on a sunny Thursday afternoon and the capital-area traffic had not yet ramped up. Getting past security at the north gate was a little tricky, even though Bill had me put on the access list. They don’t let just anyone in to Walter Reed, but after explaining the purpose of my visit, I was allowed to enter. With parking my next challenge, I found a space high up in the garage next to the new hospital building, the America Building. Bill called me just as I parked and guided me to the clinic. Then he said, “Meet me at the piano.” Piano? I found that interesting, but I’ll get back to that later.
We were in Bill’s office for only a couple of minutes. It was a fairly typical chiropractic treatment room: diagnostic equipment, elevating Leander table with auto flexion, hydrocolator tank, ultrasound unit, cold laser, etc., all strategically placed around the room. Bill also explained that this room was also his office; there was a desk, a computer for documentation and research, and an extra monitor to view imaging. Given space limitations, Bill chose to have an additional treatment room over a private office. Before I knew it, we were out of the office and starting the tour.
The Chiropractic Department shares a front desk with three other clinics: Occupational Therapy, Orthotics/Prosthetics, and Physical Medicine and Rehabilitation. It was the beginning of a discovery of integration as it should be.
Additionally, Ross is the outdoor “field and stream” manager. It is one thing to be cooped up in a state of the art rehabilitation center, but he also manages to get many guys out into the great outdoors and do something fun and physical. Hunting and fishing is very popular, including an annual event on the Eastern Shore during “Waterfowl Weekend.” Those interested get to enjoy four days of “hunting, freedom, and honor” hosted by American Legion Post 18. It is not only for experienced hunters, but also for others who discover they really can be capable once again. Here they have an opportunity to enjoy their newly developed arms proficiency without being in combat. Soldiers who had seen their young lives flash before them are reinvigorated by success found through fishing, hunting, crossbow, or biking. The newfound confidence in their physical capability is just as important as rehabilitating wounded soldiers’ mangled limbs. Inside or out, Ross Colquhoun’s contributions are great!
Next stop was the CAREN-Lab, which stands for Computer Assisted Rehabilitation Environment. This is a 9’ x 9’ high-tech motion platform with an embedded treadmill with force plates. The platform can move in every direction as well as rotate. It is suspended in front of a large curved screen on which virtual application scenes are projected along with surround sound, making it all seem very real. Nine motion capture cameras record the movements of the subject on the platform. Patients are harnessed on the platform and learn to improve and rehab gait and balance by following the path of the projected scene. Everything is recorded by the cameras and the force plates. Data is collected, computer analyzed, and progress is regularly evaluated.
The CAREN-Lab is used for amputees and those with traumatic brain injuries, vision impairment, and neurological diseases that cause ambulatory deficits. The soldiers referred by their physicians to the lab are highly motivated to be as they were prior to injury, or better. This safe, controlled place challenges the physicality of rehabilitation while expediting and improving the rehab process. In my discussions with both Bill and the lab techs, I heard a consistent theme: “It’s all about the best possible care for our wounded warriors.”
It is becoming evident that Bill is intrigued by the use of high technology to aid in advancing the quality of care. I think his favorite stop was at the GAIT lab. This large interesting room is actually the Biomechanics Laboratory and it has 23 motion-capture cameras strategically positioned to record the complex coordinated interactions between the lower limbs and the body during walking and running. Through computerized analysis, objective details of joint movement and associated forces help aid and develop clinical decision making to optimize treatment plans and correct prosthetic alignment.
The technology of the GAIT Lab largely contributed to Bill’s development of a trial study for the Fifth Joint National Capital Region Research Competition Symposium at Walter Reed. It was called “Reduction of Elective Amputations: Restoration of Function through Manual Extremity Manipulation.” At the time of my visit, 70 “case report posters” had been submitted and Bill’s Chiropractic Department’s entry was one of six finalists in the “staff and fellow” category. Stephanie Johnson, DC, now in practice in Alexandria, Virginia and a recent program intern who worked with Bill on the study, let me know that they placed second in the competition.
Bill explained that there are cases where injured patients with salvaged limbs ultimately opt for elective amputation if they don’t reach their level of functional expectations. He has found that failure can be related to limited range of motion caused by scar tissue adhesions, though. These are circumstances where chiropractic extremity procedures have been found to reach an effective level of increased function, thereby eliminating the contemplation of ultimate elective amputation. The GAIT Lab was a great place to objectively measure and record before and after progress made via chiropractic procedures.
Major Tammy Phipps is the lead driving instructor at Walter Reed. Her main objective is helping multiple amputees drive again. What is prioritized, though, is not so much about driver training or simulators; it is more about giving these wounded warriors, who have sacrificed and lost so much, the opportunity to regain personal dignity. There is a clear philosophy in this department: “Driving revives self-esteem and speeds recovery.”
Major Phipps explained to me that all effort is made on an individual, case-by-case basis to develop a vehicle adaptable to their prostheses and limitations. If a wounded warrior wants to drive, they will find a way to fit a vehicle to his needs. The gains in confidence and mental health are worth the time and cost. Additionally, there is supplemental funding available to amputees to assist in the modification of a vehicle for use in civilian life.
Back at the Chiropractic Department, Bill introduced me to another staff DC, Dr. Terence Kearney, along with longtime chiropractic assistants Rosie and Sharlene. Each treatment room is well equipped. Along with terrific integration with the other physical medicine departments, they do what we love to do: chiropractic. They treat a variety of patients, with the most challenging being, of course, the seriously “wounded warriors.” But like you and me, they also see the whole gamut of spine-related things we see every day as they treat active military, including high-ranking officers and VIPs. Just before we headed out, a young intern dropped by, Jeff Smee from NYCC. Another great thing about this operation is the opportunity some students get to work with Bill as an intern. I have met a few, including Jeff and Stephanie Johnson, who worked on the Gait Lab trial. Bill attracts highly qualified students who leave the intern program benefiting from a terrific learning experience, which is great for our profession.
Bill helped me find my way back to the parking garage. As we approached the large main entrance again, a young soldier beautifully playing the piano mesmerized me. Everyone present stopped what they were doing and just listened. Bill explained that this was not unusual. The arts remain extremely important here and it is just another way to feel normal through recovery. On top of that, well-known performers might just stop by and play a few tunes. I couldn’t help but imagine Billy Joel or Elton John rocking out at Walter Reed.
As I thanked Bill for a fun tour and interesting day, I commented that I was quite taken by all the great people I had met, the camaraderie, and the cooperative attitude of all the departments. I was also impressed especially by the overriding concept of what this hospital is willing to do to revive our wounded warriors, not only physically and functionally, but also mentally. Everywhere I went the theme seemed to be: rebuild the confidence, the self-esteem, the self-worth. To this, Bill responded, “Our nation is indebted to those who have placed themselves in harm’s way on our behalf. We strive to show every wounded hero the depths of our nation’s gratitude.”
He went on to explain that arrival at Walter Reed from combat operations is a very emotional scene. Typically, they are greeted by the admiral in charge of the hospital and an ICU contingent. Frequently, family members are present, and even more importantly, other wounded warriors. They drive home the point that not long ago, they too were mangled. With hard work ahead, though, new patients can count on healing, pulling their lives back together, and once again feeling functional and vital. The mentor side of it is just as important as the treatment. Most importantly, Bill said, they are received with a hero’s welcome.
- 107th Congress, 2001–2002. Text as of Jan 04, 2002 (Passed Congress/Enrolled Bill)
- The Library of Congress, Thomas, Bill Summary & Status 113th Congress (2013 – 2014) S.422.
- Source “Painting a Moving Train” ,Harold Kudler, M.D., Department of Veterans Affairs, and LCDR Erin Simmons, United States Navy, February, 2010.
David B. Dolberg, DC is a 1981 graduate of NYCC and has been in private practice in Springfield, Virginia since 1982. He is the 2012 Unified Virginia Chiropractic Association Chiropractor of the Year and has served as its Treasurer since 2008. He also recently became the ACA State Delegate for Virginia.
Scientific Statement from American Heart Association about Sugar Consumption and Heart Disease Risk
In 2009, the American Heart Association (AHA) issued a scientific statement6 about sugar intake and heart health, pointing out that there is evidence for a relationship between the two. According to the abstract:
“High intakes of dietary sugars in the setting of a worldwide pandemic of obesity and cardiovascular disease have heightened concerns about the adverse effects of excessive consumption of sugars.
In 2001 to 2004, the usual intake of added sugars for Americans was 22.2 teaspoons per day (355 calories per day). Between 1970 and 2005, average annual availability of sugars/added sugars increased by 19%, which added 76 calories to Americans’ average daily energy intake. Soft drinks and other sugar-sweetened beverages are the primary source of added sugars in Americans’ diets. Excessive consumption of sugars has been linked with several metabolic abnormalities and adverse health conditions, as well as shortfalls of essential nutrients…
[T]he American Heart Association recommends reductions in the intake of added sugars. A prudent upper limit of intake is half of the discretionary calorie allowance, which for most American women is no more than 100 calories per day and for most American men is no more than 150 calories per day from added sugars.”
How Much Sugar Do You Eat or Drink Each Day?
Let’s start with soda. One hundred calories isn’t much. Just one 12-ounce regular soda contains about 140 calories, which is the equivalent of 10 teaspoons of sugar. Similarly, one 8-ounce glass of orange juice has about eight full teaspoons of sugar, and at least 50 percent of that sugar is fructose. Drinking just one 8-ounce glass of orange juice will wallop your system with about 25 grams of fructose, which is more than you should have the entire day.
:dropcap_open:Around 100 years ago, the average American consumed a mere 15 grams of fructose a day, primarily in the form of whole fruit.:quoteleft_close:
Fructose has been identified as one of the primary culprits in the meteoric rise of obesity and related health problems, and while the majority of the problem is caused by the large quantities of high fructose corn syrup added to so many processed foods and sweetened beverages, naturally occurring fructose in large amounts of fruit juice is also a problem. Fructose is also a likely culprit behind the millions of US children struggling with non-alcoholic liver disease, which is caused by a build-up of fat within liver cells. Fructose is very hard on your liver, in much the same way as drinking alcohol.
Fructose at 15 grams a day is unlikely to do much harm (unless you suffer from high uric acid levels). However, at nearly 10 times that amount it becomes a MAJOR cause of obesity and nearly all chronic degenerative diseases. As a standard recommendation, I strongly advise keeping your total fructose consumption below 25 grams per day. However, for most people it would actually be wise to limit your fruit fructose to 15 grams or less, as it is virtually guaranteed that you will consume “hidden” sources of fructose from most beverages and just about any processed food you might eat.
Don’t Fall for the Latest “Designer Water” Fad
As a general rule, I advise drinking water as your primary form of beverage. Many simply do not drink enough water these days. But don’t be fooled by slick marketing. There are a number of “designer water” products available, and none of them can really beat plain, pure water. For example, on April 1, Coca-Cola released its latest enhanced water product called “Fruitwater,” which is described as “a great tasting, naturally flavored zero calorie sparking water beverage.”7 Despite its name, the product does not contain any juice. Rather it’s sweetened with sucralose and “natural fruit flavors.” Sucralose (Splenda) is an artificial sweetener that, like aspartame, is associated with a host of side effects, including:
- Gastrointestinal problems
- Seizures, dizziness, and migraines
- Blurred vision
- Allergic reactions
- Blood sugar increases and weight gain
Artificially Sweetened Water Is a Recipe for Poor Health
Different artificial sweeteners have been found to wreak havoc in a number of different ways. Aspartame, for example, has a long list of studies indicating its harmful effects, ranging from brain damage to pre-term delivery. Sucralose has been found to be particularly damaging to your intestines. A study8 published in 2008 found that sucralose:
- Reduces the amount of good bacteria in your intestines by 50 percent
- Increases the pH level in your intestines
- Affects a glycoprotein in your body that can have crucial health effects, particularly if you’re on certain medications like chemotherapy, or treatments for AIDS and certain heart conditions
In response to this study, James Turner, chairman of the national consumer education group Citizens for Health, issued the following statement:9
“The report makes it clear that the artificial sweetener Splenda and its key component sucralose pose a threat to the people who consume the product. Hundreds of consumers have complained to us about side effects from using Splenda and this study…confirms that the chemicals in the little yellow package should carry a big red warning label.”
That was nearly five years ago, yet many are still in the dark about these health risks. Having healthy gut flora is absolutely vital for your optimal health, so, clearly, any product that can destroy up to half of your healthy intestinal bacteria can pose a critical risk to your health! Many are already deficient in healthy bacteria due to consuming too many highly processed foods. This is why I recommend eating fermented vegetables every day, or at the very least taking a high quality probiotic.
Believe me, if you continuously destroy up to 50 percent of your gut flora by regularly consuming sucralose, then poor health is virtually guaranteed. So please, do not make “Fruitwater” a staple drink thinking you’re doing something beneficial for your health…Remember, pure water is a zero calorie drink. You cannot find a beverage that contains fewer calories. If you think about it, why on earth would you choose artificially sweetened water over regular mineral water? If you want some flavor, just squeeze a little bit of fresh lemon or lime into mineral water as they have virtually no fructose.
Unfortunately, most public health agencies and nutritionists in the United States still recommend these toxic artificial sweeteners as acceptable and even preferred alternatives to sugar, which is at best confusing and at worst seriously damaging the health of those who listen to this well-intentioned but foolish advice. Contrary to popular belief, research has shown that artificial sweeteners can stimulate your appetite, increase carbohydrate cravings, and stimulate fat storage and weight gain. In fact, diet sodas may actually double your risk of obesity—so much for being an ally in the battle against the bulge.
The Case Against Bottled Waters
While we’re on the subject of commercially available water products, let me remind you that bottled water in general is a bad idea. Not only are you paying about 1,900 percent more for the same or similar water you get straight from your tap, water stored in plastic bottles has other health risks as well. The plastic often used to make water bottles contains a variety of health-harming chemicals that can easily leach out and contaminate the water, such as:
- Cancer-causing PFOAs
- PBDEs (flame retardant chemicals), which have been linked to reproductive problems and altered thyroid levels
- The reproductive toxins, phthalates
- BPA, which disrupts the endocrine system by mimicking the female hormone estrogen
If you leave your water bottle in a hot car, or reuse it, your exposure is magnified because heat and stress increase the amount of chemicals that leach out of the plastic. So the container your water comes in needs to receive just as much attention as the water itself, and plastic is simply not a wise choice from a health perspective, not to mention the extreme amounts of toxic waste produced!
What’s the Healthiest Beverage You Can Drink?
Sweetened beverages sweetened with sugar, HFCS, naturally occurring fructose, or artificial sweeteners are among the worst culprits in the fight against obesity and related health problems, including diabetes, heart disease, and liver disease, just to name a few. Remember that sweetened beverages also include flavored milk products, bottled teas, and “enhanced” water products. Ditching all of these types of beverages can go a long way toward reducing your risk for chronic health problems and weight gain. So what should you drink?
Your best, most cost effective choice is to drink filtered tap water. The caveat though is to make sure you filter your tap water. I’ve written a large number of articles on the hazards of tap water, from fluoride to dangerous chemicals and drugs, as well as toxic disinfection byproducts and heavy metals, so having a good filtration system in place is more of a necessity than a luxury in most areas. Remember, nothing beats pure water when it comes to serving your body’s needs. If you really feel the urge for a carbonated beverage, try sparkling mineral water with a squirt of lime or lemon juice.
Another option to consider is to bottle your own water from a gravity-fed spring. There’s a great website called FindaSpring.com where you can find natural springs in your area. This is a great way to get back to nature and teach your children about health and the sources of clean water. The best part is that most of these spring water sources are free! Just remember to take either clear polyethylene or glass containers to collect the water so no unsafe chemicals can contaminate your water on the way home. If you choose to use glass bottles, be sure to wrap them in towels to keep them from breaking in the car.
- CNN August 31, 2011
- WebMD.com March 19, 2013
- CNN March 19, 2013
- Time magazine March 20, 2013
- New York Daily News March 11, 2013
- Circulation August 24, 2009 [Epub ahead of print]
- FoodNavigator-USA.com March 19, 2013
- Journal of Toxicology and Environmental Health 2008;71(21):1415-29
- GlobeNewsWire.com September 22, 2008
Dr. Joseph Mercola is a Chicago-based osteopathic physician armed with more than 20 years of clinical experience. In 1997, he founded Mercola.com, which is now one of the leading natural health websites in the world. Please visit Mercola.com for more information on Dr. Mercola.
:dropcap_open:The solutions are a strong political lobby with a unified chiropractic voice both nationally and statewide.:quoteleft_close:
- Studin, M. (2011, February) Personal Injury Collections by State: 2010 Comparison of Collections vs Cost of Living Analysis, The American Chiropractor, 33(2) 52-53
- CNBC (n.d.). Top States 2012: Overall Ranking, Americas Top States For Business 2012, Retrieved from: http://www.cnbc.com/id/100016697
(Schardt & Mayer, 2010, http://www.hsl.unc.edu/services/tutorials/ebm/whatis.htm).
- Clinical expertise: The clinician’s cumulated experience, education and clinical skills.
- Patient values: The patient’s own personal and unique concerns, expectations, and value.
- The best research evidence into the decision making process for patient care: The best evidence is usually found in clinically-relevant research that has been conducted using sound methodology (Schardt & Mayer, 2010, http://www.hsl.unc.edu/services/tutorials/ebm/whatis.htm).
(Schardt & Mayer, 2010, http://www.hsl.unc.edu/services/tutorials/ebm/whatis.htm).
:dropcap_open:Therefore, the second significant megatrend in chiropractic is to be prepared with the appropriate credentials and certifications. MRI spine interpretation is only one example. :quoteleft_close:
- New Jersey Department of Banking and Insurance, Retrieved from: http://www.state.nj.us/dobi/proposed/prn11_163.pdf
- Schardt , C., & Mayer, J. (2010, July). What is evidence-based practice (EBP)? Retrieved from http://www.hsl.unc.edu/services/tutorials/ebm/whatis.htm
- Carr. D. B. (2008). When bad evidence happens to good treatments. Regional Anesthesia and Pain Medicine, 33(3), 229-240.
- Sackett, D. L., Rosenberg, W. M., Gray, J. A., Haynes, R. B., & Richardson, W. S. (1996). Evidence based medicine: What it is and what it isn’t. British Medical Journal, 312(7023), 71-72.
- Lamb v Allstate Ins. Co., Docket No: ESX-L-5830-09, Sup. Ct NJ, Essex Cty (2012).
:quoteright_open:Some chiropractors may be using WBV products in their offices which have the potential to harm their patients’ skeletal systems:quoteright_close:
- Sackett DL et al. Evidence-based medicine: What it is and what it isn’t. BMJ. 1996. 312(7023):71-2.
- Lewith G (cited by Cope J): Healthwriter. April 2007, p 2. Data retrieved from http://clinicalevidence.com/ceweb/about/knowledge/jsp visited 06-05- 07
- Haneline MT: Evidence-based Chiropractic Practice, Jones and Bartlett Publishers 2007, p. 7.
- Straus SE and McAlister FA: Evidence-based medicine: a commentary on common criticisms. CMAJ. 2000. 163(7):837-41.
- McGuirk B et al.: Safety, efficiency, and cost-effectiveness of evidence-based guidelines for the management of acute low back pain in primary care. Spine. 2001. 26(23):2615-22.
- Feise R: The evidence-based approach. J Amer Chiropr Assoc. 2002. 39(8):30-3.
- Rubin C, Recker R, Cullen D, Ryaby J, McCabe J, McLeod K: Prevention of postmenopausal bone loss by a low-magnitude, high-frequency mechanical stimuli: a clinical trial assessing compliance, efficacy, and safety. J. Bone Miner. Res. 19 (3) (2004), pp. 343–351.
- Slatkovska L, Alibhai SM, Beyene J, Hu H, Demaras A, Cheung AM: Effect of 12 months of whole-body vibration therapy on bone density and structure in postmenopausal women: a randomized trial. Ann Intern Med. 2011. Nov 15;155(10):668-79, W205.
- Tarnow-Mordi WO, Healy MJR: Distinguishing between “no evidence of effect” and “evidence of no effect” in randomized controlled trials and other comparisons. Arch Dis Child, 1999. 80(3):210-11.
- Prisby et al.: Effects of whole-body vibration on the skeleton and other organ systems in man and animal models: what we know and what we need to know. Ageing Research Reviews. 7, 2008, 319-329.
- Totosy de Zepetnek et al.: Whole-body vibration and the skeletal system. JRRD. 2009;46(4):529-542.
- Iwamoto et al: Effect of whole-body vibration exercise on lumbar bone mineral density, bone turnover, and chronic back pain in post-menopausal osteoporotic women treated with alendronate, Aging Clin. Exp. Res. 17 (2) (2005), pp. 157–163.
- Merriman et al: Systematically controlling for the influence of age, sex, hertz, and time post-whole-body-vibration exposure on four measures of physical performance in community- dwelling older adults: a randomized cross-over study. Curr Geront Geriat Res. 2011.
- The Burden of Musculoskeletal Diseases in the United States: Prevalence, Societal, and Economic Cost. United States Bone and Joint Decade. Chapter 5; p. 107.
- Sedghizadeh PP et al.: Oral bisphosphonate use and the prevalence of osteonecrosis of the jaw: an institutional inquiry. JADA. 2009 Jan;140(1):61-66.
- Wysocki et al.: Whole-body vibration therapy for osteoporosis [Internet]. AHRQ Comparative Effectiveness Reviews. Rockville (MD): Agency for Healthcare Research and Quality (US); 2011 Nov. Report No.: 11(12);EUC083-EF.
- ISO Guidelines Section 2631-1: Mechanical vibration and shock – Evaluation of human exposure to whole-body vibration.
- Rubin C: Contraindications and potential dangers of the use of vibration as a treatment for osteoporosis and other musculoskeletal diseases. April 2007.
- Franchignoni F et al.: Hematuria in a runner after treatment with whole body vibration: a case report. Scand J Med Sci Sports. 2012 May 17 [Epub ahead of print].
Dr. Kevin M. Wong is an expert on foot analysis, walking and standing postures and orthotics. Teaching patients and chiropractors is a passion for him, and he travels the country speaking about spinal and extremity adjusting. Dr. Wong practices full-time in Orinda, California. Contact Dr. Wong at 925-254-4040 or [email protected].
2. Never forget, your license is a privilege to practice… not a right.
Despite the years and thousands of hours devoted to completing chiropractic college and for some, hundreds of thousands of dollars spent, never forget, your license to practice is not a right but a privilege. And like any privilege, it can be taken away. Your license is extremely valuable and should be treated as such. Do not jeopardize your license by engaging in or participating in poor business practices or joining a practice that can clearly put you at risk. Violating rules and regulations from your Board of Examiners is bad enough, but the risks do not stop there. Make sure that your new practice, or the practice you join, is in compliance at all levels, from your State Board of Chiropractic Examiners or other licensing boards to the Department of Insurance for your state. Also, consider the rules and regulations from your Provider Agreements, State and Federal Anti-kickback Statutes, the Centers for Medicare and Medicaid (CMS/Medicare) and the Office of Inspector General (OIG). While this may seem overwhelming, it really is not that hard to accomplish with the proper guidance. If and when you find there are rules that conflict, and they do at times, take the safest and most conservative approach in determining your policy and document in your compliance manual what your decision was based on. Again, protect your license. It is, in essence, your passport for life to prosperity, so guard it carefully.
3. Remember, times are never good or bad, they are just different.
You may have heard of the Mercedes ‘80s, a time when you could put anything on an insurance claim form, send it in, and a check appeared. Or perhaps you have heard the horror stories of managed care where only two visits were permitted by an insurance carrier. Having practiced through these times, as you might imagine, the truth lies somewhere in between. Never was it that easy in the 1980s, and if you documented properly to support medical necessity, rarely would you be limited to two visits. What is clear and beyond debate now is that you are entering practice at a time where all professions, including chiropractic, are under more scrutiny than ever before. There are more fraud and abuse investigations now than at any other time in history. Billions of dollars are being recouped by the federal government and insurance companies for fraudulent claims. It has been reported that the Office of Inspector General stated that for every dollar spent in healthcare fraud and abuse investigations, they recoup $17.00. So, do not look for audits to decrease; they are making money. Unfortunately, some of the scrutiny in chiropractic is warranted, and it will continue. My intent is not to instill fear, but to empower you with facts so you can minimize the risks of audits, fines and penalties and practice with some peace of mind.
Here is the UPSIDE!
:dropcap_open:Again, protect your license. It is, in essence, your passport for life to prosperity, so guard it carefully.:quoteleft_close:
More doctors are taking a look at their billing, coding and documentation and are taking steps to be more compliant with all the layers of regulations. Make sure you start off the right way by knowing and following the rules. If you are joining an existing practice, make sure you know they are aware of the rules and regulations and are proactive in making sure they are running their practice in a compliant fashion. I can tell you, far too many docs like me who have been practicing for many years ignore the fact that the rules have changed, and we must change. If you run into a great opportunity to join a practice, but the doc’s head is in the sand, use the opportunity to help them bring needed change to their practices if they are open to it. If they are not, then it is simply not in your best interest to join that practice.
4. Know how joining an existing practice can put you at risk.
When you treat a patient, whether in your own practice or not, you have an NPI number that is recorded on the claim form. The NPI identifies you as the treating/ordering doctor. Even if someone else owns the clinic, your NPI is on the claim form and you are responsible and accountable for what is on the claim form. Box 31 of the CMS 1500 form is an attestation that the information is accurate, and you agree to the statements on the reverse side of the form, including:
I certify that the services shown on this form were medically indicated and necessary for the health of the patient and were personally furnished by me or were furnished incident to my professional service by my employee under my immediate personal supervision, except as otherwise expressly permitted by Medicare or CHAMPUS regulations.
So whether you are personally responsible for sending out the claims or not, you are held responsible because you have allowed them to use your NPI number as the treating/ordering doctor, and you are at risk if the practice is not operating in a compliant fashion.
If you have decided to join an existing practice, even the family practice, there are things to consider and respectfully ask about before signing on. Yes, it is okay to ask questions of mom and dad or other family members. As a second generation chiropractor who did, I can tell you it may not be easy, but you have a right and an obligation to know some key things about the practice. Here is a short list:
- Do you have sound financial and billing policies in writing? Ask for a copy and review them.
- Is there more than one fee schedule? If so, why? And is it legal? In some states, charging more to insurance patients than you do for cash patients is considered a “dual fee schedule” and could be illegal. Ideally, there should be one fee schedule. One of the safest policies is to only offer discounts when they are part of a written financial policy, which could include contractual or network discounts, mandated fees like those established by Medicare, or when there is a documented financial hardship. Other legal discounts could include a defensible time of service or prompt payment discount, if and only if permitted in your state. If you would like a copy of a simple, one page financial policy that is rock solid, send an email to [email protected] and put FORM in the subject line.
- Does the clinic up code, or down code based on the type of insurance coverage? Meaning, do they bill a higher level of Evaluation & Management code for PI or Worker’s Compensation cases and a low-level code just because they are cash patients?
- Do you waive deductibles or co-payments? This is clearly a violation of rules and regulations and most provider agreements unless a true financial hardship is established by the clinic.
- Do you have a written financial policy that is covered with patients? Many complaints to Boards of Examiners seem to be triggered by a poor financial policy, which is easily eliminated by written policy.
- Does the clinic have a compliance plan in place to minimize the potential for fraud and abuse and to ensure compliance with all layers of regulations? There are many steps that can be taken today to minimize the potential for audits and mitigate potential fines and penalties.
- Has the practice ever been audited? If so, what was the outcome? Today, it is not a matter of if you will be audited, but when. And, keep in mind, just because there has been an audit does not mean someone did something wrong. It could just be their number came up.
Finally, despite what seems like a list of overwhelming decisions and concerns, you are embarking on a career as a doctor of chiropractic at a time that has opportunities like we have never seen before. Expect the best, give your best to the profession and your patients, and you will not be disappointed.
Dr. Foxworth is a certified Medical Compliance Specialist and President of ChiroHealthUSA. A practicing Chiropractor, he remains “in the trenches” facing challenges with billing, coding, documentation and compliance. He has served as president of the Mississippi Chiropractic Association, former Staff Chiropractor at the G.V. Sonny Montgomery VA Medical Center and is a Fellow of the International College of Chiropractic. He founded ConservaCareCorp, the first chiropractic network selected by the State of Mississippi to serve over 195K covered lives in the State Health Plan. You can contact Dr. Foxworth at 1-888-719-9990, [email protected] or visit the ChiroHealthUSA website at www.chirohealthusa.com